Quality Reporting in the New Payment Models Carol L. Henwood, DO, FACOFP dist. Iowa Osteopathic Association 33 rd Annual Winter Update December 2014

COPD CHF SIADH ESRD HNPCC RA NAFL D HTN PVD CAD CMPY GERD BPH IBD IBS PE

PCMH AHRQ CMMI PCPCC MRA NCQ A AC O

HEDIS CG-CAHPS 5-STAR

Outcomes and Evaluations Stating the Facts: Cost, Quality and Outcomes in the Medical Neighborhood PCMH Initiatives 172 at onset 118 evaluated as had external payment reform support 85% NCQA recognition NO initiatives in MI, MS, UT, HI 56% Payment FFS + PMPM + P4P Of 56%, shared savings 38% Multi-payor Initiatives Min PMPM$0.50$3.94 Max PMPM$9$11.25

The Triple Aim Improved Health Enhanced Patient Experience of Care Reduced Cost [+1: Improved Productivity]

TEAM T imely E vidence-based and E ffective A ccessible M easureable

HEDIS: HEDIS: Healthcare Effectiveness Data and Information Set HEDIS Percentiles 2007 HEDIS Percentiles 2012 Breast Cancer Screening Cervical Cancer Screening Diabetes Care (HgbA1c<7) Diabetes Care (HgbA1c>9)35-23 BP Control (<140/90mmHg)

Pay for Performance (P4P) BETTER CARE FOR INDIVIDUALS Patient/Caregiver Experience Care Coordination and Safety BETTER HEALTH FOR POPULATIONS Preventative Health At Risk Population – Diabetes At Risk Population – Hypertension At Risk Population – Ischemic Vascular Disease At Risk Population – Heart Failure At Risk Population – Coronary Artery Disease

P4P phase in from reporting to performance Methods of Reporting Claims Survey EHR Incentive Program Reporting PQRS Web Interface

CAHPS Clinician and Group Surveys (CG-CAHPS) Visit Survey PCMH Item Set Health Information Technology Item Set

Version 2.0 Items refer to “this provider” VS “this doctor” Items about access to care (urgent/non urgent) modified to ask could they get an appointment as soon as they needed VS as soon as they THOUGHT they needed Item asking about getting easy to understand instructions were modified from taking of health problems to health questions Item whether patient had seen a doctor of other health care provider 3 or more times for the same health condition was simplified to ask whether they got health care 3 or more times for the same health problem

Link to CAHPS Overview of Questions Rating of provider Would recommend provider to family and friends Demographics Provider showed concern for patient’s physical comfort Patient and provider talked about the cost of the prescription Provider interrupted patient when patient was talking Provider asked the patient what patient thought was best for patient

Source: United Health Care. “Stars: Quality Measures Overview.” Available HTTP:

Moving Forward Payment = FFS + P4P + PCMH

ACOFP ACOFP is proud to introduce ACOFP Quality Markers program!

Diabetes: Quality Reporting

Quality Improvement Reporting: All Diabetes Measures

Diabetes: LDL Reporting Care Opportunities: LDL Patients

Coronary Artery Disease: Quality Reporting

Quality Improvement Reporting: CAD: All Measures

Hypertension: Quality Reporting

Quality Improvement Reporting

Patient Care Summary